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1. Background Nepal has a short and slowly developing history of psychiatry. Recent political turmoil has crippled Nepalese healthcare in rural areas. Although the final quarter of the 20th century saw some development of psychiatric services in Nepal, the majority of Nepalese people remain deprived of such services even today. There is no national health program or Mental Health Act. Psychiatric services are hospital based and most are centralized in the capital. The United Nations classifies Nepal as one of the least developed countries in the world, with a per capita income of just 150. Nearly two-fifths of the population lives on less than 90p a day. It is predominantly a rural country where only 15% of the population live in urban areas. Less than 3% of gross domestic product is spent on the healthcare system and only 0.8% of the healthcare budget is spent on mental health. There are no national morbidity data for mental illness either in primary or secondary care. The prevalence of mental disorders in Nepal apparently does not differ from that of other countries in the south Asia region. According to Dr Kan Tun (personal communication, 2006), the World Health Organization (WHO) representative to Nepal, around 1% of the population has severe mental illness and 10-20% milder mental health problems. A survey of two developing towns in western Nepal in 1998 revealed a high point prevalence (35%) of conspicuous psychiatric morbidity (Upadhyaya & Pol, 2003). About 2% of people with that degree of morbidity have been reported to suffer from incapacitating illnesses requiring continuous support. The current situation would certainly be different as a decade-long Maoist insurgency has caused immense social upheaval.
2. Introduction Psychiatry, as a branch of medicine pertaining to the study and treatment of mental disease (Tunner, 1984:551), has for the most part continued to ignore socio-cultural factors in its theoretical and applied approaches to mental disorders. Due to the significant influence of biological medicine on psychiatry, there has been a persistent focus on the disease conception regarding its study. This assumes that mental Kshitiz Gurung and Sanam Kala Rai MSW 1st year/ 2nd semester
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3. National Mental Health Facilities Scenario Nepal is a rural country. The majority of its population depends on agriculture and farming. The complete absence of a social welfare net is a major obstacle to the development and delivery of mental healthcare. Most people think that mental illness means becoming crazy or lunatic, being possessed by spirits or losing control of oneself (Regmi et al, 2004). Although healthcare professionals are becoming more aware of mental health problems (Shyangwa et al, 2003), the majority of rural Nepalese people still believe that mental illness is caused by bad fortune. There are no national morbidity data for mental illness either in primary or secondary care. The prevalence of mental disorders in Nepal apparently does not differ from that of other countries in the south Asia region. According to Dr Kan Tun (personal communication, 2006), the World Health Organization (WHO) representative to Nepal, around 1% of the population has severe mental illness and 10-20% milder mental health problems. A survey of two developing towns in western Nepal in 1998 revealed a high point prevalence (35%) of conspicuous psychiatric morbidity (Upadhyaya & Pol, 2003). About 2% of people with that degree of morbidity have been reported to suffer from incapacitating illnesses requiring continuous support. The current situation would certainly be different as a decade-long Maoist insurgency has caused immense social upheaval. Kshitiz Gurung and Sanam Kala Rai MSW 1st year/ 2nd semester Page 2
4. Social cultural factors and Psychology Human beings and their cultures are not separable but interdependent and reflective of one another. The culture of individuals will interact with biological, psychological and environmental variables to determine the causes and manifestations of mental disorder; human beings and their culture cannot be separated. Moreover, culture is not simply incidental to mental disorders and therapy. Rather, it is a basic variable that interacts with biological, psychological and environmental variables in determining the causes, manifestations and treatment of the entire spectrum of mental disorders (Marsella and White, 1982: ix). Whereas social factors like unemployment, migration, life stress, social perceptions, race, gender, class hierarchy, religion, conflicts, war, traditional mindset of the people and other factors play active role for people to suffers from psycho-social problems.
The effects of socio-cultural factors on form, course and outcome of major psychiatric disorders can be considered as pathoplastic, i.e., shaping rather than causing psychopathology. However, there are situations of socio-cultural change in which the stress of acculturation or deculturation exerts pathogenic effects which lead in a Kshitiz Gurung and Sanam Kala Rai MSW 1st year/ 2nd semester
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7. References: Dhungel Bidushi, THE DEEP END, Kantipur Publications, The Kathmandu Post, Features, Saturday March 31 2012, Page 8 Nepal mental health country profile2004, Vol. 16, No. 1-2 , Pages 142149 S. K. Regmi, A. Pokharel, S. P. Ojha, S. N. Pradhan and G. Chapagain Psychiatric Bulletinpb.rcpsych.org; The Psychiatrist (2007) 31: 348-350 doi: 10.1192/pb.bp.107.014571
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Anthropology
THERELATIONOFSOCIALFACTORTOPHYSICALANDPSYCHIATRICILLNESS.ht m http://www.mentalhealth.com/mag1/wolfgang.html
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